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Appendix: Definitions of Orthodontic Services

Definition for Orthodontic Services provided by Reen & Reen, DMD, P.C. during the audit period.

Table of Contents

Definitions of Orthodontic Services


Procedure Code

Service Definition / MassHealth Coverage*

Interceptive Orthodontic Treatment


Treatment intended to prevent or minimize the need for comprehensive orthodontic treatment.

Comprehensive Orthodontic Treatment


Placing initial bands around the molars and affixing brackets and wire is referred to as banding of the braces. MassHealth pays for this procedure only once per member under the age of 21. This procedure requires prior authorization based on clinical standards and includes a series of measurements made by the orthodontist that represent the degree to which a member’s teeth deviate from normal alignment.

Fixed Appliance Therapy


Treatment to control a habit such as thumb sucking by using a fixed orthodontic appliance.

Periodic Orthodontic Treatment


Ongoing orthodontic visits to monitor progress and make any necessary adjustment to the bands or wires. MassHealth providers are allowed to bill these visits on a quarterly basis as long as the member was seen at least once in that quarter.

Orthodontic Retention/Removal


Services including the removal of the braces, construction and placement of retainers, and follow-up visits. MassHealth pays for a maximum of five retention visits.

Orthodontic Treatment—Alternative Billing


Pre-orthodontic workup, which includes radiographs, photographs, and measurements required on the authorization forms. If MassHealth denies a member for comprehensive orthodontic treatment, the provider can bill this code to be reimbursed for the pre-orthodontic workup.

Replacement of Lost/Broken Retainer


Replacement of a lost or broken retainer. MassHealth will pay for a replacement only during the two-year retention period.

Unspecified Orthodontic Service


Services for which there is no other orthodontic code. A provider must describe the procedure in detail when using this code.

*    These definitions are paraphrased from the MassHealth Dental Manual (Section 420.431 of Title 130 of the Code of Massachusetts Regulations) and the American Dental Association’s 2015 Code on Dental Procedures and Nomenclature.

Date published: June 8, 2018